Prediction models for the viability of pulmonary metastatic lesions after chemotherapy in nonseminomatous germ cell tumors

Tsunezuka, Hiroaki; Nakamura, Toshio; Fujikawa, Kei; Shimomura, Manabu; Okada, Satoru; Shimada, Junichi; Teramukai, Satoshi; Ukimura, Osamu; Inoue, Masayoshi

doi:10.1111/iju.14162

Cited by 3 publications

(5 citation statements)

References 27 publications

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“…In the present study, Tsunezuka et al 1 operated on 40 patients and 326 pulmonary lesions after chemotherapy for the germ cell tumor. This is the first report with many specimens, precise histological examination and clinical background that can predict the viability in a lung specimen.…”

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confidence: 87%

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Editorial Comment to Prediction models for the viability of pulmonary metastatic lesions after chemotherapy in nonseminomatous germ cell tumors

Kishida

2020

Int J of Urology

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Editorial Comment to Prediction models for the viability of pulmonary metastatic lesions after chemotherapy in nonseminomatous germ cell tumorsIn the present study, Tsunezuka et al. 1 operated on 40 patients and 326 pulmonary lesions after chemotherapy for the germ cell tumor. This is the first report with many specimens, precise histological examination and clinical background that can predict the viability in a lung specimen. Histological examinations showed 73 (22%) viable cells, which include 46 (16%) teratomas and/or 37 (11%) residual cancer cells, whereas the other 253 (78%) lesions were necrosis or fibrosis. The findings that the cancer cells mainly composed of yolk sac tumor are very interesting and have never been reported before.The authors carried out multivariate analyses and showed that the predictors associated with cancer cells were as follows: (i) elevated tumor markers; (ii) multiregimen chemotherapy; (iii) increased tumor size 6 months before surgery; and (iv) yolk sac tumor in the primary lesion. Among these predictors, elevated tumor markers and increased tumor size before operation are common sense among urologists. Operation under these circumstances is so-called "desperation surgery," which usually results in a poor outcome. What we really wanted to know is the factors that will predict a better prognostic outcome, even in the desperation surgery; however, they did not discuss this issue in this article. According to their findings, what should we do in the clinical practice? Whether they do not recommend pulmonary metastasectomy in the high-risk group, or even in the high-risk group, is it still worth carrying out desperation surgery? If they can provide us with such information, it would be really useful for prioritizing pulmonary metastasectomy. Another limitation of this study is that they did not show the level of positivity of tumor markers. If the human chorionic gonadotropin (HCG) elevation is slight (e.g. 1-5 mIU/mL), they might be false positive or decrease to a normal level spontaneously. Further-more, the authors measured free-beta HCG (ng/mL), that is more likely to show false positives than the total HCG (mIU/ mL). In the previous study about salvage surgery with elevated tumor markers, patients with elevated alpha fetoprotein alone (i.e. normal HCG levels) were shown to have a better prognosis. 2 However, in that study, only a small number (n = 2) of lung metastasis were included. When the authors provide their data using proper HCG measurement, they might be able to show a different strategy in lung metastasis.Despite these limitations, the authors' analysis of pulmonary metastasectomy in the treatment of germ cell tumor is the first report so far, and provides us with a great deal of precious consideration in this lesion. Further analysis including long-term prognosis will be expected. References 1 Tsunezuka H, Nakamura T, Fujikawa K et al. Prediction models for the viability of pulmonary metastatic lesions after chemotherapy in nonseminomatous germ cell tumors. Int. J. Uro...

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confidence: 87%

“…In the present study, Tsunezuka et al 1 . operated on 40 patients and 326 pulmonary lesions after chemotherapy for the germ cell tumor.…”

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confidence: 95%

Editorial Comment to Prediction models for the viability of pulmonary metastatic lesions after chemotherapy in nonseminomatous germ cell tumors

Kishida

2020

Int J of Urology

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“…While very small nodules may sometimes be observed, his were larger than 9 mm and he had teratoma in his primary tumor, both of which are risk factors for teratoma in residual lung nodules. 18,51,52 He consented, and the operation was completed without significant complications. The histopathology from the resection showed teratoma with a differentiated rhabdomyomatous component.…”

Section: Suggested Approaches To Managementmentioning

confidence: 99%

“…18 Patients with lung nodules smaller than 10 mm and with no teratoma in the primary tumor are more likely to have necrosis/fibrosis only. 51,52…”

Section: Challenges In Diagnosis and Management And Review Of The Rel...mentioning

confidence: 99%

“…18 Patients with lung nodules smaller than 10 mm and with no teratoma in the primary tumor are more likely to have necrosis/fibrosis only. 51,52 When there are multiple liver or lung lesions, sampling one or more is sometimes performed if complete resection is not possible. If viable cancer is found, that may justify salvage chemotherapy, and if teratoma is found, that may affect decisions about additional resections and the frequency of surveillance imaging.…”

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confidence: 99%

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Resection of Residual Masses After Chemotherapy for Metastatic Nonseminomatous Germ Cell Tumors in Adolescents and Adults

Gilligan

2023

JCO

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The Oncology Grand Rounds series is designed to place original reports published in the Journal into clinical context. A case presentation is followed by a description of diagnostic and management challenges, a review of the relevant literature, and a summary of the authors' suggested management approaches. The goal of this series is to help readers better understand how to apply the results of key studies, including those published in the Journal of Clinical Oncology, to patients seen in their own clinical practice. Optimal treatment of patients with testicular germ cell tumors requires a coordinated multidisciplinary approach, so that surgery, chemotherapy, and, when appropriate, radiation therapy can be integrated into a coherent and comprehensive treatment plan. Nonseminomatous germ cell tumors (NSGCT) are often a mixture of teratoma and cancer (choriocarcinoma, embryonal carcinoma, seminoma, and/or yolk sac tumor). While the cancers are highly sensitive to and often cured by chemotherapy, teratoma is resistant to chemotherapy and radiation therapy and generally must be resected surgically to be successfully treated. Therefore, the standard of care for metastatic NSGCT is to resect all resectable residual masses after chemotherapy. If such resection reveals only teratoma and/or necrosis/fibrosis, then patients are put on a surveillance schedule to monitor for relapse. If viable cancer is found and there are positive margins or 10% or more of any of the residual masses consists of viable cancer, then two cycles of adjuvant chemotherapy should be considered.

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LAPTM5 Plays a Key Role in the Diagnosis and Prognosis of Testicular Germ Cell Tumors

Zhang

et al. 2021

International Journal of Genomics

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Objective. Testicular germ cell tumors (TGCT) are a serious malignant tumor with low early diagnosis rates and high mortality. Methods. To investigate novel biomarkers to predict the diagnosis and prognosis of this cancer, bioinformatics analysis was used as an accurate, efficient, and economical method. Results. Our study detected 39 upregulated and 589 downregulated differentially expressed genes (DEGs) using the GEO and TCGA databases. To identify the function of DEGs, GO functional analysis, three pathway analysis (KEGG, REACTOME, and PANTHER), and protein-protein interaction network were performed using the KOBAS website, as well as the String database. After a series of analyses in GEPIA and TIMER, including differential expression, we found one candidate gene related to the prognosis and diagnosis of TGCT. LAPTM5 was also associated with CD8+ T cell and PDCD1 expression, which suggests that it may affect immune infiltration. Conclusions. LAPTM5 was identified as a hub gene, which could be used as a potential biomarker for TGCT diagnosis and prognosis.

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Prediction models for the viability of pulmonary metastatic lesions after chemotherapy in nonseminomatous germ cell tumors

Cited by 3 publications

References 27 publications

Editorial Comment to Prediction models for the viability of pulmonary metastatic lesions after chemotherapy in nonseminomatous germ cell tumors

Editorial Comment to Prediction models for the viability of pulmonary metastatic lesions after chemotherapy in nonseminomatous germ cell tumors

Resection of Residual Masses After Chemotherapy for Metastatic Nonseminomatous Germ Cell Tumors in Adolescents and Adults

LAPTM5 Plays a Key Role in the Diagnosis and Prognosis of Testicular Germ Cell Tumors

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